Rabbinical authorities in some ultra-Orthodox Jewish communities maintain that direct orogenital suction is an integral part of ritual circumcision; other ultra-Orthodox authorities permit removal of blood by other means (e.g., a glass tube). Oral suction of an open wound poses an inherent risk for transmission of HSV-1 and other pathogens to a newborn infant and is not safe.

The practice, known as metzitzah b’peh, is no longer prevalent in most Jewish circumcisions, but is still performed in ultra-Orthodox communities.

In September, a baby died after contracting herpes from controversial ritual, the second in the New York area to die in recent years due to metzitzah b’peh complications.